Cryoanalgesia enhances recovery from minimally invasive repair of pectus excavatum resulting in reduced length of stay: A case-matched analysis of NSQIP-Pediatric patients

Arshad, Seyed A.; Hatton, Gabrielle E; Ferguson, Dalya M.; Li, Linda T.; Austin, Mary T.; Tsao, Kuo Jen; Sponsor, Paps

doi:10.1016/j.jpedsurg.2021.03.017

Cited by 23 publications

(27 citation statements)

References 10 publications

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“…3,5,6 Similarly, the application of thoracoscopic cryoanalgesia has been able to provide long-lasting pain control, decreased hospital stay, and reduced opioid use, as reflected in the series published so far. 2,4,[17][18][19][20][21][22][23] With the aim of further improving the use of cryotherapy and avoiding possible complications related to thoracoscopy, 21 we applied ultrasound-guided percutaneous cryotherapy prior to the Nuss procedure obtaining encouraging results in terms of hospital stay, pain, and opioid use. Since the effect of cryotherapy begins approximately 6 to 10 hours after application and in some studies even exceeds 24 hours, we wanted to optimize the procedure by performing it 48 hours prior to the shorter hospital stay (LOS) and with less use of opioids and less pain, which were significant findings.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

et al. 2021

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Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

et al. 2021

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“…The intraoperative intercostal nerve cryolysis procedure itself is a safe procedure. The following complications are described in the literature mainly in adults: persistent neuropathic pain, hyperaesthesia, temporary pain in the operated area, bleeding from a wound or deep structures, lung damage, clinically significant pneumothorax, haematoma ( 20 ). Graves et al reported persistent numbness up to several months in two children undergoing Nuss procedure ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the “BackOnFeet” application prepared by our interdisciplinary educational and training team improves and accelerates recovery, gives the patient a sense of influence on their disease and the recovery process, which translates into an enthusiastic reception. The “BackOnFeet” application facilitates educational process which is key aspect of ERAS protocol ( 14 , 20 ). We suggest to use our “BackOnFeet” application in the future studies.…”

Section: Discussionmentioning

confidence: 99%

Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application—a new strategy to improve outcomes

et al. 2023

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“…8 Several studies based on the application of thoracoscopic cryoanalgesia in MIRPE conclude a shorter hospital stay, reduced opioid consumption, and less pain compared with conventional techniques. 3,[9][10][11][12][17][18][19][20] As already described in the literature, the effect of cryoanalgesia can vary between 6 and 48 hours after application. In 2021, we conducted a study comparing patients in whom PCr was applied on the same day of PE surgery and those in whom it was applied 48 hours before surgery.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

et al. 2022

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Introduction The addition of ultrasound-guided percutaneous cryoanalgesia (PCr) for pain management after pectus excavatum (PE) surgery offers a new and advantageous approach. Our aim is to describe our experience with PCr applied on the same day, 24 hours, and 48 hours prior to PE surgery. Material and Methods Prospective pilot study in patients undergoing ultrasound-guided PCr (2019–2022) was divided into three groups: PCr on the same day of surgery (PCrSD), PCr 24 hours before (PCr24), and PCr 48 hours before (PCr48). We describe the application of technique and data obtained by comparing the three groups. Results We present 42 patients (25 PCrSD, 11 PCr24, 6 PCr48). PCr24 had a shorter procedure duration than PCrSD (65.8 vs. 91.2 minute; p = 0.048). Related to analgesia, PCr24 and PCr48 showed lower opioid consumption than PCrSD in PCA volume (48.5 and 49.6 vs. 75.1 mL; p = 0.015) and PCA time (23.3 and 23.8 vs. 34.3 hours; p = 0.01). Degree of pain (VAS scale) on the day of surgery and on the second postoperative day was lower in PCr24 and PCr48 than in PCrSD (4 and 2 vs. 5; p = 0.012; 0 and 1 vs. 2; p = 0.01, respectively) as well as shorter hospital stay (3 and 3.5 vs. 5 days; p = 0.021). In addition, PCr24 showed lower opioid consumption and hospital stay than PCr48 (p > 0.05). The greatest savings in hospital costs were obtained in the PCr24 group. Conclusion PCr48 and PCr24 prior to PE surgery offers lower opioid consumption, less pain and shorter hospital stay than PCrSD. PCr24 is comparable to PCr48, but seems to show advantages and simpler logistics for the patient and the hospital.

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Cryoanalgesia enhances recovery from minimally invasive repair of pectus excavatum resulting in reduced length of stay: A case-matched analysis of NSQIP-Pediatric patients

Cited by 23 publications

References 10 publications

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Intercostal nerve cryoanalgesia in the treatment of pain in patients operated on by the modified Nuss method with the BackOnFeet application—a new strategy to improve outcomes

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

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